Sleep problems very common among young children receiving treatment for psychiatric disorders

Sleep disorders may be under-diagnosed in children with behavioral and emotional issues, yet can affect wellbeing greatly

John Boekamp, Ph.D., clinical director of the Pediatric Partial Hospital Program (PPHP) at Bradley Hospital recently led a study that found sleep difficulties - particularly problems with falling asleep - were very common among toddlers and preschool-aged children who were receiving clinical treatment for a wide range of psychiatric disorders. The study, titled "Sleep Onset and Night Waking Insomnias in Preschoolers with Psychiatric Disorders," is now published online in the journal Child Psychiatry & Human Development.

"The most common sleep difficulties reported nationally for toddlers and preschoolers are problems of going to bed, falling asleep and frequent night awakenings – collectively, these problems are referred to as behavioral insomnias of childhood," said Boekamp. "Sleep problems in young children frequently co-occur with other behavioral problems, with evidence that inadequate sleep is associated with daytime sleepiness, less optimal preschool adjustment, and problems of irritability, hyperactivity and attention."

Boekamp's team was interested in learning more about sleep and sleep problems in young children with behavior problems, as early sleep problems may be both a cause and consequence of children's difficulties with behavioral and emotional self-regulation. "Essentially, these young children might be caught in a cycle, with sleep disruption affecting their psychiatric symptoms and psychiatric symptoms affecting their sleep-wake organization," said Boekamp.

The partial program that Boekamp leads at Bradley Hospital is a family-centered, intensive day treatment program for very young children aged from newborn to six who have serious emotional, behavioral or relationship disturbances. This study examined the nature and prevalence of diagnostically defined sleep disorders, including Sleep Onset Insomnia (SOI) and Night Waking Insomnia (NWI), in a group of 183 young children admitted to the program. Diagnosable sleep disorders, particularly SOI, were quite common in the group, exceeding previous estimates obtained in community settings. Overall, 41 percent of children in the study also met diagnostic criteria for a sleep disorder. Sleep problems were especially common in children with disruptive behavior, attention, anxiety and mood problems.

"It is important for families to be aware of how important sleep is to the behavioral adjustment and wellbeing of young children," said Boekamp. "Sleep disorders may be unrecognized and under-diagnosed in young children, particularly when other behavioral or emotional problems are present."

Difficulties with sleep may be particularly important to address when children are also struggling with challenging daytime behaviors, such as problems with compliance, aggression, attention and mood. Sleepiness and fatigue may exacerbate these problem behaviors.

"This study is a great reminder that it's critical for mental health providers working with young children and their families to ask about children's sleep," said Boekamp. "Simple questions about children's sleep patterns, including how long it takes a child to fall asleep at night and how frequently a child awakens after falling asleep, may yield important information that is relevant to clinical care, even when sleep problems are not the primary focus of treatment."

Boekamp's primary affiliation is Bradley Hospital, a partner in the Lifespan health system in Rhode Island. He is also clinical assistant professor in the department of psychiatry and human behavior at The Warren Alpert Medical School of Brown University.

Source: Lifespan